The present invention relates to a bougie device and method of use thereof, and more particularly relates to a device for gripping and directing a bougie device which is suitable for guiding insertion of an endotracheal tube into an airway of a person.
A bougie may have numerous uses in medicine, but are commonly used to widen a passageway or guide another instrument into a passageway. An intubation aide commonly known as the “gum elastic bougie” is a thin, solid or hollow, cylinder of rubber, plastic or another material that a physician inserts into a body passageway. Within the art of tracheal intubation, bougies are frequently used as a guide for the correct placement of an endotracheal tube. Bougies are also used to provide suction or oxygen delivery within a body passageway.
Bougies generally require a necessary level of flexibility so that they can navigate a body passageway, with the required flexibility resulting in bougies that are hard to grip. Devices have been designed to assist in intubation of the bougie, i.e. guiding the bougie, but such devices still have limitations in allowing for adequate gripping of the bougie so that it can be properly navigated during a procedure.
In many medical situations endotracheal intubation is a critical procedure performed to secure a patient's airway. To facilitate insertion of an endotracheal tube, a physician, paramedic or other medical personnel will use a laryngoscope blade which is inserted down a patient's throat. The laryngoscope blade is primarily used to move the tongue and the epiglottis from the providers view in order to provide a clear passage to the vocal cords. Placement of the endotracheal tube correctly in the patient's trachea must be done quickly to avoid hypoxic brain injury to the patient. The task of endotracheal intubation becomes more challenging in emergent situations, patients with difficult airways and those that are at high risk for aspiration.
Commonly in the operating room prior to induction of general anesthesia patients are given 100% oxygen to breath in effort to replace nitrogen in the lungs with oxygen. This process is known as preoxygenation and serves to fill the lungs with oxygen like a reservoir. When patients undergo general anesthesia they become apneic and must rely on the oxygen reservoir within the lungs to provide oxygen for the bodies basic metabolic needs. Sufficient preoxygenation adequately fills the lungs with oxygen to provide more time for the medical personnel to instrument the airway and attempt endotracheal intubation.
Evaluation of a patient's airway allows physicians to gauge the difficulty that may be encountered when attempting endotracheal intubation. Certain clinical features of patient such a large neck circumference, obesity, history of sleep apnea, small mouth opening, and overbite among, others are predictors of a difficult endotracheal intubation. Once a patient has been deemed to have a difficult airway, the physician may obtain equipment such as a video laryngoscope or intubation aide like the bougie. A physician may have a poor view of a patient with a difficult airway of the vocal cords under direct laryngoscopy, which would make endotracheal intubation difficult. The bougie is vital tool in the difficult airway as it has a bended tip that facilitates its passage into the patient's trachea.
Commonly found within hospitals is suction tubing with a handle attached, also known as a yankauer, which are used to aspirate fluid within the patient's airway. Under direct laryngoscopy, the yankauer provides direct vision of the patient's vocal cords. In an effort to overcome these problems, medical personnel often insert the yankauer to remove blood, oral secretions, or gastric content prior to proper placement of the endotracheal tube. After aspiration of fluid within the pharynx the suction device must be removed and an endotracheal tube must be inserted within the trachea. This two step procedure of clearing secretions, gastric contents, or blood with the suction tube removing it and then grabbing an endotracheal tube results in lost time. However, these prior art processes use valuable time, along with the patient's oxygen reservoir, switching between devices. Moreover, even when suction tube is inserted into the mouth it is possible fluids to reaccumulate in between the time suction tube is removed and endotracheal tube insertion.
If an intubation attempt fails, then the patient must be ventilated with bag and mask device which can force air down the trachea as well as down the esophagus. When the stomach is extended with air, patient becomes more likely to vomit and aspirate. A distended abdomen also decreases a patient's lung compliance and makes it more difficult to ventilate. Moreover, repeated intubation involves instrumenting the airway with laryngoscope blade which causes trauma to the patient which can result in bleeding and edema. It is vital that endotracheal intubation be accomplished quickly, accurately, atraumatically and on consistently on the first attempt. Repeated attempts with intubation often make endotracheal intubation even more challenging. A distended abdomen from bag-mask ventilation, bleeding, or edema can obstruct the physician's view of the vocal cords and places the patient at risk for aspiration. This is a common problem with the current intubation procedure with a difficult airway has been taking time to exchange between using the bougie, yankauer, and the endotracheal tube. This lost time puts the patient at risk for aspiration pneumonia, aspiration pneumonitis, or hypoxic brain injury.
U.S. Pat. No. 5,257,620 describes an airway device that has a suction stylet that telescopically disposed therein and attached to the endotracheal tube. The suction stylet is connected to a suction source which allows suction forces to withdraw fluids continuously. During the intubation process, if continuous suction forces at the distal suction stylet are present it can cause trauma to the vocal cords. Furthermore, a suction device that lacks complete control by the provider may be problematic as continuous suction in the oropharynx will also remove oxygen from the patient. Continuous suction of oxygen from the patient oropharynx will hasten the development of hypoxia. This takes away valuable time the provider has when attempting to intubate the patient and must revert to bag-mask ventilation. As hypoxia develops patients are at risk for developing anoxic brain injury and even cardiac arrest.
U.S. Pat. No. 5,595,172 describes a device that includes a suction stylet that is inserted into an endotracheal tube and allows the provider to control suction. The stylet has a main body with a central passageway along the main body and a vent arm that extends off the main body. The vent arm has a vent port that allows the provider to utilize suction with occlusion of the vent port. This device may offer a suction stylet that can be only be used to clear secretions but does not function as an intubation aide.